• Clinical Review Nurse…

    Centene Corporation (Carson City, NV)
    …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
    Centene Corporation (10/30/25)
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  • Associate Manager RN Denials Management

    Banner Health (NV)
    …thoroughly completes documentation required for claims payment of services approved through concurrent review 2. Supervises the team to ensure internal/external ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
    Banner Health (11/01/25)
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  • Medical Director (NV)

    Molina Healthcare (Las Vegas, NV)
    …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
    Molina Healthcare (10/31/25)
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  • Med Mgmt Clinician Sr (US)

    Elevance Health (Las Vegas, NV)
    … clinical staff. + Conducts and may approve pre-certification, concurrent , retrospective, out of network and/or appropriateness of treatment setting reviews ... not require the training or skill of a registered nurse . Acts as a resource for more junior Clinicians....equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. +… more
    Elevance Health (10/29/25)
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  • Case Manager (RN)

    Prime Healthcare (North Las Vegas, NV)
    …cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity ... accredited school of nursing and a current state Registered Nurse license2. Grandfathered prior to April 1, 2015. Minimum...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five… more
    Prime Healthcare (10/14/25)
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